Sheyla Maria Lemos Lima

Use of clinical guidelines and the results in primary healthcare for hypertension

This study aimed to identify strategies to implement clinical guidelines for hypertension in a primary healthcare unit, focusing on the effects of the Family Health Program (FHP) and government Pharmaceutical Home Delivery Program (PHDP) on adherence to guidelines by health professionals and the results of care. The data were obtained from a registry of 5,499 hypertensive patients, stratified according to registration in the FHP and PHDP. The random selection procedure resulted in samples of 150 patient charts in three strata and one stratum (without the FHP or PHDP) with only 22 patient charts. Descriptive statistics and linear regression models were obtained, incorporating the structural information from the sample design (sample strata and weight). Based on information recorded on the patient charts, adherence to clinical guidelines was extremely low. A positive effect had been expected from the FHP and PHDP in terms of adherence to clinical guidelines and results of care. A trend towards a positive effect was observed for the PHDP and a slightly favorable performance for the FHP for adherence to clinical guidelines.

Caracterização gerencial dos hospitais filantrópicos no Brasil

This paper presents the management characteristics of charity hospitals in Brazil, based on data from a national survey developed in 2001. The sample accounted for the random inclusion of 66 Brazilian Unified Health System (SUS) inpatient care providers with less than 599 beds and all 26 hospitals with at least 599 beds. It also included 10 institutions assumed as non-providers of services to the SUS. The analyses are descriptive, focusing on the classification of the hospitals according to their managerial development level, as well as selected issues regarding the utilization of specific managerial technologies, human resources, technical services, and services contracting. Distinct managerial levels were identified, but it is important to note that 83% of the SUS providers with less than 599 beds were classified as having incipient management. The authors discuss implications of the findings for inpatient care policies, considering the importance of charity hospitals for the Brazilian Health System.

Estudo de satisfação dos beneficiários de planos de saúde de hospitais filantrópicos

This paper presents the findings of research aimed at identifying and analyzing the argumentation and rationale that justify the satisfaction of consumers with their health plans. The qualitative method applied used the focus group technique, for which the following aspects were defined: the criteria for choosing the health plans which were considered, the composition of the group and its distribution, recruitment strategy, and infrastructure and dynamics of the meetings. The health plan beneficiaries were classified into groups according to their social class, the place where they lived, mainly, the relationship that they established with the health plan operators which enabled us to develop a typology for the plan beneficiaries. Initially, we indicated how the health plan beneficiaries assess and use the Brazilian Unified Health System (SUS), and, then, considering the types of plans defined, we evaluated their degree of satisfaction with the different aspects of health care, and identified which aspects mostly contributed explain their satisfaction.

Caracterização assistencial de hospitais filantrópicos no Brasil

OBJECTIVE To characterize the Brazilian philanthropic hospital network and its relation to the public and private sectors of the Sistema Unico de Saude (SUS) [Brazilian Unified Health System]. METHODS This is a descriptive study that took into consideration the geographic distribution, number of beds, available biomedical equipment, health care complexity as well as the productive and consumer profiles of philanthropic hospitals. It is based on a sample of 175 hospitals, within a universe of 1,917, involving 102 distinct institutions. Among these, there were 66 Brazilian Unified Health System (SUS) inpatient care providers with less than 599 beds randomly included in this study. Twenty-six of the twenty-seven SUS inpatient care providers with at least 599 beds, as well as ten institutions which do not provide their services to SUS, were also included. This is a cross-sectional study and the data was obtained in 2001. Data collection was conducted by trained researchers, who applied a questionnaire in interviews with the hospitals managers. RESULTS Within the random sample, 81.2% of the hospitals are located in cities outside of metropolitan areas, and 53.6% of these are the only hospitals within their municipalities. Basic clinical hospitals, without ICUs, predominate within the random sample (44.9%). Among the individual hospitals of the large philanthropic institutions and the special hospitals, the majority -- 53% and 60% respectively -- are level II general hospitals, a category of greater complexity. It was verified that complexity of care was associated to hospital size, being that hospitals with the greatest complexity are situated predominantly in the capitals. CONCLUSIONS Given the importance of the philanthropic hospital sector within the SUS [Unified Health System] in Brazil, this paper identifies some ways of formulating appropriate health policies adjusted to the specificities of its different segments.

A contratualização nos Hospitais de Ensino no Sistema Único de Saúde brasileiro

Sao discutidas as possibilidades e os limites da contratualizacao para a melhoria do desempenho, o incremento da prestacao de contas, o aprimoramento da gestao, a melhoria da assistencia e a maior insercao dos hospitais de ensino na rede de servicos no âmbito do Programa de Reestruturacao dos Hospitais de Ensino no Sistema Unico de Saude/SUS. Quatro hospitais contratados e suas secretarias contratantes sao entrevistados. Segundo os dirigentes de hospitais, e fragil a associacao entre contratualizacao e a presenca de mecanismos de insercao na rede, de praticas e estruturas de qualificacao assistencial e gerencial nos hospitais. Hospitais mais estruturados assistencial e gerencialmente apresentaram uma contratualizacao mais estruturada com a secretaria. Houve um aumento de producao da media complexidade ambulatorial e uma diminuicao dos procedimentos de atencao basica em todos os hospitais. Sugere-se o desenvolvimento gerencial continuo do hospital e da secretaria, a revisao do plano operativo, orcamento, mecanismos de monitoramento e sistema de incentivos, pactuacao com as equipes, dentre outros.

DOTS in primary care units in the city of Rio de Janeiro, Southeastern Brazil

OBJETIVO: Descrever a implantacao e os efeitos do directly-observed treatment short course (DOTS) em centros municipais de saude. METODOS: Foram realizadas entrevistas com profissionais dos nove centros municipais de saude que ofereciam DOTS no Rio de Janeiro, RJ, em 2004-2005. Foram coletados os dados de todos os centros municipais de saude da cidade sobre os tratamentos de tuberculose iniciados em 2004. Analises bivariadas e modelo multinomial foram aplicados para identificar associacoes entre resultados do tratamento e variaveis demograficas e relativas ao processo de tratamento, incluindo estar em DOTS ou terapia auto-administrada (SAT). RESULTADOS: Dos 4.598 casos de tuberculose tratados, 1.118 (24,3%) utilizaram DOTS e 3.480 (75,7%), SAT. As chances de uso de DOTS foram maiores entre pacientes com menos de 50 anos, recidiva de tuberculose, historia previa de abandono ou falencia de tratamento. As chances de morte foram 52,0% maiores entre pacientes em DOTS comparados aqueles em SAT. A modalidade de tratamento com maior sucesso foi DOTS com agentes comunitarios de saude. Foi observada reducao de 21,0% na razao de chances de abandono (vs. cura) entre pacientes em DOTS, comparados a pacientes em SAT, e reducao de 64,0% entre pacientes em DOTS com ACS, comparados aqueles sem. CONCLUSOES: Pacientes com perfil de menor adesao ao tratamento tenderam a ser incluidos em DOTS. Essa estrategia melhora a qualidade da atencao provida a pacientes com tuberculose, ainda que metas propostas nao tenham sido atingidas.

Hospitais filantrópicos e a operação de planos de saúde próprios no Brasil

OBJECTIVE To describe the management performance of philanthropic hospitals that operate their own health plans, in comparison with philanthropic hospitals as a whole in Brazil. METHODS The managerial structures of philanthropic hospitals that operated their own health plans were compared with those seen in a representative group from the philanthropic hospital sector, in six dimensions: management and planning, economics and finance, human resources, technical services, logistics services and information technology. Data from a random sample of 69 hospitals within the philanthropic hospital sector and 94 philanthropic hospitals that operate their own health plans were evaluated. In both cases, only the hospitals with less than 599 beds were included. RESULTS The results identified for the hospitals that operate their own health plans were more positive in all the managerial dimensions compared. In particular, the economics and finance and information technology dimensions were highlighted, for which more than 50% of the hospitals that operated their own health plans presented almost all the conditions considered. CONCLUSIONS The philanthropic hospital sector is important in providing services to the Brazilian Health System (SUS). The challenges in maintaining and developing these hospitals impose the need to find alternatives. Stimulation of a public-private partnership in this segment, by means of operating provider-owned health plans or providing services to other health plans that work together with SUS, is a field that deserves more in-depth analysis.

Estrutura e qualidade assistencial dos prestadores de serviços hospitalares à saúde suplementar no Brasil

This study aimed to characterize inpatient care providers for health plans in Brazil, considering that knowledge on healthcare providers is still incipient, particularly in relation to healthcare structure and quality. A national survey was performed, focusing on 3,817 hospitals. A stratified sample of 83 hospitals was selected, and data were collected from September to December 2006 using interviews with hospital administrators. Hospital care was characterized using variables related to installed capacity and services output, as well as practices and structures for healthcare quality assurance and control. The final sample consisted of 74 hospitals, representing an estimated universe of 3,799 hospitals. Inpatient care providers for health plans, mainly for the Unified National Health System (SUS), showed limited presence of structures and practices for improving management and healthcare quality.

Avaliação do SISVAN na gestão de ações de alimentação e nutrição em Minas Gerais, Brasil

The scope of this article is to evaluate the SISVAN as a tool for planning, management and evaluation of food and nutrition actions in primary healthcare in the Unified Health System (SUS). It involved a cross-sectional study composed of a stratified random sample of the municipalities in the State of Minas Gerais. The subjects of the research were municipal officials of SISVAN who filled out a structured questionnaire. Descriptive analysis of the data was performed with the construction of simple and bivariate tables. It was observed that those responsible for SISVAN, collect (50%) and input (55%) weight, height, and food consumption data; whereas 53%, 59% and 71% do not analyze and do not recommend or perform nutrition actions, respectively. This being the case, most of those responsible do not use the information for planning, management and evaluation of food and nutrition traits. The findings show that the SISVAN is not used to its full potential; the data generated have not been used for planning, management and evaluation of nutrition services in primary healthcare in the SUS.

Tuberculosis Control Program and patient satisfaction, Rio de Janeiro, Brazil

OBJECTIVE To evaluate factors associated with users’ satisfaction in the Tuberculosis Control Program. METHODS A cross-sectional study of 295 patients aged ≥ 18 years, with two or more outpatient visits in the Tuberculosis Control Program, in five cities in the metropolitan region of Rio de Janeiro, RJ, Southeastern Brazil, in 2010. Considering an estimated population of 4,345 patients, the sampling plan included 15 health care units participating in the program, divided into two strata: units in Rio de Janeiro City, selected with probability proportional to the monthly average number of outpatient visits, and units in the other four cities. In the units, four temporal clusters of five patients each were selected with equal probability, totaling 300 patients. A questionnaire investigating the users’ clinical and sociodemographic variables and aspects of care and service in the program relevant to user satisfaction was applied to the patients. Descriptive statistics about users and their satisfaction with the program were obtained, and the effects of factors associated with satisfaction were estimated. RESULTS Patients were predominantly males (57.7%), with a mean age of 40.9 and with low level of schooling. The mean treatment time was 4.1 months, mostly self-administered (70.4%). Additionally, 25.8% had previously been treated for tuberculosis. There was a high level of satisfaction, especially regarding medication provision, and respect to patients by the health professionals. Patients who were younger (≤ 30), those on self-administered treatment, and with graduate level, showed less satisfaction. Suggestions to improve the services include having more doctors (70.0%), and offering exams in the same place of attendance (55.1%). CONCLUSIONS Patient satisfaction with the Tuberculosis Control Program was generally high, although lower among younger patients, those with university education and those on self-administered treatment. The study indicates the need for changes to structural and organizational aspects of care, and provides practical support for its improvement.